Physical Therapy Diagnosis and Management of a Patient with Chronic Daily Headache: A Case Report

Abstract

Chronic headaches are a significant health problem for patients and often a clinical enigma for the medical professionals who treat such patients. The purpose of this case report is to describe the physical therapy diagnosis and management of a patient with chronic daily headache. The patient was a 48-year-old woman with a medical diagnosis of combined common migraine headache and chronic tension-type headache. An exacerbation of these long-standing headache complaints had resulted in a chronic daily headache for the preceding eight months. Symptoms included bilateral headache, neck pain, left facial pain, and tinnitus. Outcome measures used included the Henry Ford Hospital Headache Disability Inventory (HDI) and the Neck Disability Index (NDI). Examination revealed myofascial, articular, postural, and neuromuscular impairments of the head and neck region. Treatment incorporated myofascial trigger point dry needling, orthopaedic manual physical therapy, exercise therapy, and patient education. On the final visit, the patient reported no headaches during the preceding month. There was a 31% improvement in the HDI emotional score, a 42% improvement in the functional score, and a 36% improvement in the total score for the HDI, the latter exceeding the minimal detectable change for the total score on this measure. The NDI at discharge showed an 18% improvement with a maximal improvement during the course of treatment of 26%. Both improvements exceeded the minimal clinically important difference for the NDI. This case report indicates that physical therapy diagnosis and management as described may be indicated for the conservative care of patients with chronic headaches.

Immediate Effects of Inhibitive Distraction on Active Range of Cervical Flexion in Patients with Neck Pain: A Pilot Study

“…Trigger points in the head and neck region have been implicated in the reported headache and central sensitization in patients with tension-type headache. Their referral patterns correspond to the pain characteristics and distribution reported by patients with cervicogenic headache, occipital neuralgia, and migraine headache 3 . Studies have reported signifi cantly greater numbers of active MTrPs in the suboccipital muscles of patients with tension-type headache and in patients with migraine headache when compared to asymptomatic controls [14][15][16] .…”

“…In a cross-sectional population survey, Guez et al 2 found an 18% prevalence for chronic neck pain (>6 months' duration). Headache types associated with cervical spine dysfunction include tensiontype and cervicogenic headache, occipital neuralgia, and-to a lesser extent-migraine headaches 3 . Tension-type headache affects two-thirds of men and over 80% of women in developed countries 4 .…”

Manual Physical Therapy in the Netherlands: Reflecting on the Past and Planning for the Future in an International Perspective

“…The N=1-trial and also less methodologically rigorous case reports and case series are clinic-friendly designs that help construct our evidence pyramid. I have enjoyed reading the recent examples of this type of design published in JMMT 45,46 . My suggestion is to critically evaluate the evidence pyramid for different areas of MPT.…”

JVA, Mastication and Digital Occlusal Analysis in Diagnosis and Treatment of Temporomandibular Disorders

“…Temporomandibular joint disorder is a functional disturbance. Temporomandibular joints, masticatory muscles, teeth, bones and the central nerve system are all involved in TMJ pathology [3][4][5][6]. For many years, clinicians have employed various mechanical tools for diagnosis and to understand the reasons for the problem [7].…”

“…It has been advocated in textbooks on occlusion [2,3,[5][6][7] that mark area is a representative of the load contained within the mark. Legends to photographs depicting occlusal adjustment technique end results and paper mark appearance describe that large and dark marks indicate heavy load, and that smaller and light marks indicate lesser loads [5][6][7].…”